Volunteer Application

If you would like to include a portrait image of yourself to be included with your profile you may do so. Please choose an image file that is 2MB or less in file size.

Portrait

First Name *

Last Name *

Street Address (Primary) *

City (Primary) *

Zip/Postal Code (Primary) *

Country (Primary) *

State (Primary) *

Email (Primary) *

Phone (Primary) *

Please check your area(s) of interest.

Areas of interest *

General Volunteer Bank

Disaster Response

Military Outreach

Outreach to Under-served

Please list any other areas of interest.

Other Areas of Interest

Please enter your employment (title and description).

Employment *

Please briefly describe your personal and professional, skills or areas of expertise which would contribute to your involvement in HTPA community volunteer activities.

Skills or areas of expertise

Please list any current licenses and/or professional certification(s) (e.g. MD, RN, LMT).

Licenses or Professional Certifications

Please enter the number of hours you are willing to donate evenings, weekdays and weekends.

Hours willing to donate *

Please select your last Healing Touch Level completed.

Last Healing Touch Level Completed *

(clear)

Please list any additional HT classes completed (e.g. AP1, AP2, etc).

Additional HT Classes Completed

Are you a Healing Touch Certified Practitioner? *

Yes No

If you answered "Yes" to being a Healing Touch Certified Practitoner please enter the year certified. (YYYY)

Since what year you were certified as a Practitioner?

Are you a Healing Touch Certified Instructor? *

Yes No

If you answered "Yes" to being a Healing Touch Certified Instructor please enter the year certified. (YYYY)

Since what year you were certified as an Instructor?

Are you a member of HTPA? *

Yes No

If you answered yes to being a member of HTPA please enter your member number.

HTPA Member Number

Do you have liability insurance? *

Yes No

Please upload a recent resume in a word document (doc) format. Name the file with your name. Example: jane_smith_resume.doc.

Resume *

Please select today's date.

Volunteer Application Date *

(clear)

HTPA Community Connections

Volunteer Application